The surgical approach to high-grade spondylolisthesis at the lumbosacral junction remains controversial. Appropriate surgical techniques can be challenging with the potential for high complication rates, particularly with reduction. Multiple techniques have been described including posterior only reduction and instrumentation, posterior only instrumentation with in situ arthrodesis, and anterior-posterior reduction and instrumentation. Regardless of technique, the operative goals are to provide sufficient stability and biological support to promote bony fusion, maintain global balance, and decompress the neural elements while avoiding neurological complications. During instrumentation of a high-grade spondylolisthesis at the lumbosacral junction, it can be difficult to obtain access to the L5–S1 disc space for interbody insertion. We present a novel technique for improving access to the L5–S1 disc space through an osteotomy of the anterior-inferior aspect of the L5 vertebral body as part of a 2-stage circumferential fusion in the treatment of high-grade spondylolisthesis in an adolescent.

腰骶交界处高度滑脱的手术方法仍存在争议。适当的手术技术可能具有挑战性，可能会出现高并发症率，尤其是复位术。已经描述了多种技术，包括仅后路复位和内固定、仅后路复位和原位关节固定术以及前后复位和内固定。无论采用何种技术，手术目标都是提供足够的稳定性和生物支持，以促进骨融合，维持整体平衡，并对神经元件减压，同时避免神经并发症。在腰骶交界处进行高度滑脱的手术时，可能很难进入 L5-S1 椎间盘间隙进行椎间插入。我们提出了一种新技术，通过对 L5 椎体的前下方进行截骨术，作为治疗青少年重度脊椎滑脱的 2 阶段圆周融合的一部分，以改善进入 L5-S1 椎间盘空间的通道。